Sugar-sweetened beverage taxes in Brazil: past, present, and future

The Limits to Food and Beverage Industry Influence over Fiscal and Regulatory Policy in Latin America

CONTEXT

Little is known about the political, institutional, and social contexts contributing to a decline in food and beverage industry power and influence over fiscal policy (soda taxes) and regulatory policy (sales/advertising restrictions and food labels). This article addresses this issue by exploring why Mexico and Chile eventually saw such a decline in the food and beverage industry's influence, whereas a similar decline did not occur in Brazil. The article argues that in Mexico and Chile, these outcomes are explained by presidential, congressional, and bureaucratic interests shifting to pursue policies that went against industry preferences.

METHODS

This article took a qualitative methodological approach to comparative historical research.

FINDINGS

Policy makers' interest in pursuing stronger food and beverage regulations were shaped by economic and public health concerns, new electoral contexts, epidemiological information, and normative beliefs. In Mexico, the infiltration of nutrition researchers within government facilitated this process. By contrast, Brazil's government was divided about pursuing regulatory policies, with presidents favoring partnerships with industry to implement a popular antihunger program; industry's power endured there with limited progress in policy reforms.

CONCLUSION

Governments can eventually overcome industry power and policy influence, but it depends on a whole-government commitment to reform.

Inequalities in oral health: estimating the longitudinal economic burden of dental caries by deprivation status in six countries

BACKGROUND

The recent World Health Organization (WHO) resolution on oral health urges pivoting to a preventive approach and integration of oral health into the non-communicable diseases agenda. This study aimed to: 1) explore the healthcare costs of managing dental caries between the ages of 12 and 65 years across socioeconomic groups in six countries (Brazil, France, Germany, Indonesia, Italy, UK), and 2) estimate the potential reduction in direct costs from non-targeted and targeted oral health-promoting interventions.

METHODS

A cohort simulation model was developed to estimate the direct costs of dental caries over time for different socioeconomic groups. National-level DMFT (dentine threshold) data, the relative likelihood of receiving an intervention (such as a restorative procedure, tooth extraction and replacement), and clinically-guided assumptions were used to populate the model. A hypothetical group of upstream and downstream preventive interventions were applied either uniformly across all deprivation groups to reduce caries progression rates by 30% or in a levelled-up fashion with the greatest gains seen in the most deprived group.

RESULTS

The population level direct costs of caries from 12 to 65 years of age varied between US10.2 billion in Italy to US$36.2 billion in Brazil. The highest per-person costs were in the UK at US$22,910 and the lowest in Indonesia at US$7,414. The per-person direct costs were highest in the most deprived group across Brazil, France, Italy and the UK. With the uniform application of preventive measures across all deprivation groups, the greatest reduction in per-person costs for caries management was seen in the most deprived group across all countries except Indonesia. With a levelling-up approach, cost reductions in the most deprived group ranged from US$3,948 in Indonesia to US$17,728 in the UK.

CONCLUSION

Our exploratory analysis shows the disproportionate economic burden of caries in the most deprived groups and highlights the significant opportunity to reduce direct costs via levelling-up preventive measures. The healthcare burden stems from a higher baseline caries experience and greater annual progression rates in the most deprived. Therefore, preventive measures should be start early, with a focus on lowering early childhood caries and continue through the life course.

Added Sugar and Oral Health: A Position Paper of the Brazilian Academy of Dentistry

Excessive sugar consumption is the main cause of dental caries. Dental caries is highly prevalent and negatively impacts the quality of life at all stages. Furthermore, sugar consumption is associated with other noncommunicable conditions and diseases, such as obesity, diabetes, and cardiovascular diseases. The aim of this paper is to propose recommendations at the individual and population levels for health professionals, families, educators, stakeholders, and public officials to reduce the burden of dental caries and other noncommunicable diseases that are caused by the excessive sugar intake. A systematic search was performed in PubMed and Cochrane databases to investigate the effectiveness of strategies and policies aiming to reduce sugar consumption as well as the impact of different patterns of sugar consumption on the occurrence of dental caries. Reference list of the identified papers and practice guidelines were manually reviewed as well. Based on the best evidence available, the Brazilian Academy of Dentistry recommends not to offer sugars to children younger than 2 years of age, and to limit total sugar consumption to <25 g per day after 2 years of age. Furthermore, families should be informed to limit sugar exposure, sugar-free areas should be available, content of food labels and advertisement should be regulated, taxation of products with sugar should be introduced, and reformulation of foods and drinks to reduce concentrations of sugars should be considered.